A diagnostic dye having a peak spectral absorption of about 800 nm is indocyanine green. It is used to calculate blood flow, liver function, and cardiac output.

Indocyanine green Uses:

• Cardiac/hepatic function diagnostics:

  • It is employed to estimate cardiac output, liver blood flow, and liver function.

• Ophthalmic angiography:

  • It is also used for ophthalmic angiography.

Indocyanine green Dose in adults:

The adult dose of indocyanine green for measuring cardiac output: 

• A cardiac catheter was used to quickly provide 5 mg intravenously, up to a maximum dose of 2 mg/kg.

Note:

• In order to perform a diagnostic cardiac catheterization, 5 dilution curves are often required.
• Doses are usually injected in 1 mL volume.
• To prevent hemolysis, flush the dye from the catheter with saline.

Ophthalmic angiography:

• Depending on the imaging tool and procedure, up to 40 mg intravenously
• The injection is followed immediately with a 5 mL bolus of NS.

Hepatic function studies:

• The patient should be in a fasting basal state
• 0.5 mg/kg intravenously

Indocyanine green Dose in children:

Indocyanine green dose in Children for Cardiac output determination: IV:

Note:

• In order to perform a diagnostic cardiac catheterization, five dilution curves are often required.
• Doses are usually injected in 1 mL volume.
• To prevent hemolysis, flush dye from the catheter with saline.

• Children and Adolescents:

  • 5 mg injected via a cardiac catheter rapidly to the highest total dose of 2 mg/kg

• Infants:

  • 25 mg is injected via a cardiac catheter rapidly.
  • The highest total dose is 2 mg/kg

Hepatic function studies:

• Infants, Juveniles, and Adolescents:

  • Refer to adult dosing.

Pregnancy Risk Category: C

• The drug has not yet been tested in human or animal reproduction studies.

Use of Indocyanine Green during Breastfeeding

• It is unknown if the drug will be excreted into breast milk.
• It is recommended that you use it with caution if you are breastfeeding.

Dose in Kidney Disease:

There are no dosage adjustments provided in the manufacturer's labeling.

Dose in Liver disease

There are no dosage adjustments provided in the manufacturer's labeling.

Side effects of Indocyanine green:

• Gastrointestinal:

  • Feces discoloration (green)

• Central nervous system:

  • Headache

• Miscellaneous:

  • Anaphylactoid reactions
  • Diaphoresis

• Dermatologic:

  • Pruritus
  • Urticaria
•  

Contraindications to Indocyanine green:

Allergy to iodides

Warnings and precautions

• Anaphylaxis

  • Severe hypersensitivity reactions can occur, which may manifest as hypotension or anaphylactic shock.
  • Patients who have suffered from anaphylaxis during catheterization procedures have died.

Monitoring Parameters:

None mentioned.

How to administer Indocyanine green?

Cardiac output determination:

• Use a cardiac catheter to deliver one bolus of the dye into the targeted locations in the circulatory system as quickly as feasible when doing dye dilution curves.
• Use a 1 ml amount to inject the medication. The process calls for five dilution curves on average.
• A needle or catheter should be used to sample the dye-blood mixture from a systemic arterial sampling site while a recording device, such as an oximeter or densitometer, is linked to the needle or catheter.
• Use sterile water to rinse the syringe; isotonic saline should be used to flush any remaining cardiac catheter dye into the bloodstream to prevent hemolysis.
• In all other steps of the catheterization operation, saline should be used.

Hepatic function studies:

• The dye is injected into the vein (into the antecubital vein) as rapidly as possible without letting it out of the vein.
• Before injecting the dye for the development of the standard curve and serum blank, 6 ml of venous blood from the patient's arm should be taken in the event that a photometric approach is used.
• The right amount of dye should be injected into the same vein. Using ear oximetry is another option.

Ophthalmic angiography studies:

• The dye is administered as a rapid intravenous bolus into the antecubital vein and is followed by a rapid bolus of 5 ml normal saline.

The way that Indocyanine Green works is as follows:

A tricarbocyanine dye called indocyanine green makes it possible to record indicator-dilution curves for use in research and diagnosis. It is not affected by changes in oxygen saturation.

Protein binding:

• 95% to albumin

Half-life elimination:

• 2.5 to 3 minutes

Excretion:

• Bile

International Brand Names of Indocyanine green:

• IC Green
• Spy Agent Green
• Aurogreen
• Diagnogreen
• ICG-Pulsion
• Infracyanine

Indocyanine green Brand Names in Pakistan:

No Brands Available in Pakistan.